Prevention of facial pressure ulcers using the Mayfield clamp for sacral tumor resection

Sacral neoplasm resection is managed via partial or total sacrectomy that is performed via the Kraske approach. The combination of the patients positioning and the relatively long operative time required for this procedure increase the risk of pressure ulcers. Facial pressure ulcers can cause tissue necrosis and/or ulceration in a highly visible area, leading to a cosmetically disfiguring lesion. Here, the authors report the use of a Mayfield clamp in the positioning of patients undergoing sacral tumor resection to prevent facial pressure ulceration. After the patient is placed prone in the Kraske or Jackknife position, the hips and knees are flexed with arms to the side. Then while in the prone position, the patient is physically placed in pins, and the Mayfield clamp is fixated at the center of the metal arch via the Mayfield sitting adapter to the Andrews frame, suspending the head (and face) over the table. The authors find that this technique prevents the development of facial pressure ulcers, and it has the potential to be used in patients positioned in the Kraske position for other surgical procedures.

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Sacral tumor resection and the impact on pelvic incidence

Journal of Neurosurgery Spine ◽

10.3171/2010.9.spine09728 ◽

2011 ◽

Vol 14 (1) ◽

pp. 78-84 ◽

Cited By ~ 10

Author(s):

Oren N. Gottfried ◽

Ibrahim Omeis ◽

Vivek A. Mehta ◽

Can Solakoglu ◽

Ziya L. Gokaslan ◽

...

Keyword(s):

Pelvic Incidence ◽

Tumor Resection ◽

Surgical Techniques ◽

Clinical Importance ◽

Johns Hopkins Hospital ◽

En Bloc ◽

Sacral Tumor ◽

Si Joint ◽

The Impact ◽

Total Sacrectomy

Object Pelvic incidence (PI) directly regulates lumbar lordosis and is a key determinant of sagittal spinal balance in normal and diseased states. Pelvic incidence is defined as the angle between the line perpendicular to the S-1 endplate at its midpoint and the line connecting this point to a line bisecting the center of the femoral heads. It reflects an anatomical value that increases with growth during childhood but remains constant in adulthood. It is not altered by changes in patient position or after traditional lumbosacral spinal surgery. There are only 2 reports of PI being altered in adults, both in cases of sacral fractures resulting in lumbopelvic dissociation and sacroiliac (SI) joint instability. En bloc sacral amputation and sacrectomy are surgical techniques used for resection of certain bony malignancies of the sacrum. High, mid, and low sacral amputations result in preservation of some or the entire SI joint. Total sacrectomy results in complete disruption of the SI joint. The purpose of this study was to determine if PI is altered as a result of total or subtotal sacral resection. Methods The authors reviewed a series of 42 consecutive patients treated at The Johns Hopkins Hospital between 2004 and 2009 for sacral tumors with en bloc resection. The authors evaluated immediate pre- and postoperative images for modified pelvic incidence (mPI) using the L-5 inferior endplate, as the patients undergoing a total sacrectomy are missing the S-1 endplate postoperatively. The authors compared the results of total versus subtotal sacrectomies. Results Twenty-two patients had appropriate images to measure pre- and postoperative mPI; 17 patients had high, mid, or low sacral amputations with sparing of some or the entire SI joint, and 5 patients underwent a total sacrectomy, with complete SI disarticulation. The mean change in mPI was statistically different (p < 0.001) for patients undergoing subtotal versus those undergoing total sacrectomy (1.6° ± 0.9° vs 13.6° ± 4.9° [± SD]). There was no difference between patients who underwent a high sacral amputation (partial SI resection, mean 1.6°) and mid or low sacral amputation (SI completely intact, mean 1.6°). Conclusions The PI is altered during total sacrectomy due to complete disarticulation of the SI joint and discontinuity of the spine and pelvis, but it is not changed if any of the joint is preserved. Changes in PI influence spinopelvic balance and may have postoperative clinical importance. Thus, the authors encourage attention to spinopelvic alignment during lumbopelvic reconstruction and fixation after tumor resection. Long-term studies are needed to evaluate the impact of the change in PI on sagittal balance, pain, and ambulation after total sacrectomy.

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Gait-simulating fatigue loading analysis and sagittal alignment failure of spinal pelvic reconstruction after total sacrectomy: comparison of 3 techniques

Journal of Neurosurgery Spine ◽

10.3171/2013.12.spine13386 ◽

2014 ◽

Vol 20 (4) ◽

pp. 364-370 ◽

Cited By ~ 3

Author(s):

Aaron J. Clark ◽

Jessica A. Tang ◽

Jeremi M. Leasure ◽

Michael E. Ivan ◽

Dimitriy Kondrashov ◽

...

Keyword(s):

Load Transfer ◽

Fatigue Testing ◽

Tumor Resection ◽

Early Mobilization ◽

Fatigue Loading ◽

Axial Rotation ◽

Intact Specimen ◽

Flexion Extension ◽

Sacral Tumor ◽

Total Sacrectomy

Object Reconstruction after total sacrectomy is a critical component of malignant sacral tumor resection, permitting early mobilization and maintenance of spinal pelvic alignment. However, implant loosening, graft migration, and instrumentation breakage remain major problems. Traditional techniques have used interiliac femoral allograft, but more modern methods have used fibular or cage struts from the ilium to the L-5 endplate or sacral body replacement with transiliac bars anchored to cages to the L-5 endplate. This study compares the biomechanical stability under gait-simulating fatigue loading of the 3 current methods. Methods Total sacrectomy was performed and reconstruction was completed using 3 different constructs in conjunction with posterior spinal screw rod instrumentation from L-3 to pelvis: interiliac femur strut allograft (FSA); L5–iliac cage struts (CSs); and S-1 body replacement expandable cage (EC). Intact lumbar specimens (L3–sacrum) were tested for flexion-extension range of motion (FE-ROM), axial rotation ROM (AX-ROM), and lateral bending ROM (LB-ROM). Each instrumented specimen was compared with its matched intact specimen to generate an ROM ratio. Fatigue testing in compression and flexion was performed using a custom-designed long fusion gait model. Results Compared with intact specimen, the FSA FE-ROM ratio was 1.22 ± 0.60, the CS FE-ROM ratio was significantly lower (0.37 ± 0.12, p < 0.001), and EC was lower still (0.29 ± 0.14, p < 0.001; values are expressed as the mean ± SD). The difference between CS and EC in FE-ROM ratio was not significant (p = 0.83). There were no differences in AX-ROM or LB-ROM ratios (p = 0.77 and 0.44, respectively). No failures were noted on fatigue testing of any EC construct (250,000 cycles). This was significantly improved compared with FSA (856 cycles, p < 0.001) and CS (794 cycles, p < 0.001). Conclusions The CS and EC appear to be significantly more stable constructs compared with FSA with FE-ROM. The 3 constructs appear to be equal with AX-ROM and LB-ROM. Most importantly, EC appears to be significantly more resistant to fatigue compared with FSA and CS. Reconstruction of the load transfer mechanism to the pelvis via the L-5 endplate appears to be important in maintenance of alignment after total sacrectomy reconstruction.

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Laparoscopic Sleeve Gastrectomy versus Laparoscopic Banded Sleeve Gastrectomy: First Prospective Pilot Randomized Study

Gastroenterology Research and Practice ◽

10.1155/2016/6419603 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 8

Author(s):

Valeria Tognoni ◽

Domenico Benavoli ◽

Emanuela Bianciardi ◽

Federico Perrone ◽

Simona Ippoliti ◽

...

Keyword(s):

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Operative Time ◽

Intraoperative Complications ◽

Randomized Study ◽

Control Group ◽

Bodyweight Loss ◽

Relevant Difference ◽

Banded Sleeve Gastrectomy ◽

Time Required

Introduction. The placement of ring or band around the gastric tube might prevent the dilation after Laparoscopic Sleeve Gastrectomy (LSG). We describe the first randomized study comparing LSG and Laparoscopic Banded Sleeve Gastrectomy (LBSG).Material and Method. Fifty obese patients were enrolled in the study between January 2014 and January 2015. We analysed differences in operative time, complication rate, mortality, and BMI between the two groups over a period of 12 months.Results. Twenty-five patients received LSG (group A) and 25 LBSG (group B). The mean preoperative BMI was47.3±6.58 kg/m2and44.95±5.85 kg/m2, respectively, in the two groups. There was no statistical relevant difference in operative time. No intraoperative complications occurred. Mean BMI registered after 3, 6, and 12 months in groups A and B, respectively, were37.86±5.72 kg/m2and37.58±6.21 kg/m2(p=0.869),33.64±6.08 kg/m2and32.03±5.24 kg/m2(p=0.325), and29.72±4.40 kg/m2and27.42±4.47 kg/m2(p=0.186); no statistical relevant difference was registered between the two groups.Conclusion. LBSG is a safe and feasible procedure. The time required for the device positioning did not influence significantly the surgical time. The results of bodyweight loss did not document any statistically significant differences among the two groups, even though LBSG group showed a mean BMI slightly lower than that of the control group.

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Modified Instruments for Wrist Fusion

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681_86_90272-x ◽

1986 ◽

Vol 11 (2) ◽

pp. 245-249

Author(s):

J. K. STANLEY ◽

S. R. GUPTA ◽

M. G. HULLIN

Keyword(s):

Surgical Procedures ◽

Operative Time ◽

Intramedullary Fixation ◽

Early Mobilisation ◽

Wrist Arthrodesis ◽

Wrist Fusion ◽

New Instruments

A technique and new instruments for intramedullary fixation of the wrist arthrodesis is described, based on the technique of Clayton, popularised by Nalebuff and Millender. This allows early mobilisation, secure fixation and simplicity of the technique. It also allows other surgical procedures to be performed under the same anaesthetic and tourniquet due to the reduction in operative time.

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Skin Perfusion, Arterial and Venous Blood Flow, and Soft Tissue Thickness in Relation to Pressure Ulcers

Volume 1A: Abdominal Aortic Aneurysms; Active and Reactive Soft Matter; Atherosclerosis; BioFluid Mechanics; Education; Biotransport Phenomena; Bone, Joint and Spine Mechanics; Brain Injury; Cardiac Mechanics; Cardiovascular Devices, Fluids and Imaging; Cartilage and Disc Mechanics; Cell and Tissue Engineering; Cerebral Aneurysms; Computational Biofluid Dynamics; Device Design, Human Dynamics, and Rehabilitation; Drug Delivery and Disease Treatment; Engineered Cellular Environments ◽

10.1115/sbc2013-14496 ◽

2013 ◽

Author(s):

Abinand Manorama ◽

Tamara Reid Bush

Keyword(s):

Blood Flow ◽

Pressure Ulcers ◽

Venous Blood ◽

The Body ◽

Venous Blood Flow ◽

Tissue Necrosis ◽

Tissue Thickness ◽

Skin Perfusion ◽

Healthcare Settings ◽

Soft Tissue Thickness

Pressure ulcers have been a concern in healthcare settings, with more than 50% of bedridden or wheelchair-bound patients being affected [1]. Pressure ulcers typically occur on a region of the body that experiences forces from an external structure (e.g. bed, wheelchair). Researchers believe that such forces cause a decrease in blood flow, which results in tissue necrosis, causing pressure ulcers [2].

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Novel Graft Technique for Lumbopelvic Reconstruction After Sacral Tumor Resection

JBJS Case Connector ◽

10.2106/jbjs.cc.20.00269 ◽

2021 ◽

Vol 11 (2) ◽

Author(s):

Robert F. McLain

Keyword(s):

Tumor Resection ◽

Sacral Tumor

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Usefulness of tumor traction with a snare and endoclips in gastric submucosal tumor resection: a propensity-score-matching analysis

Gastroenterology Report ◽

10.1093/gastro/goaa050 ◽

2020 ◽

Author(s):

Qiang Zhang ◽

Jian-Qun Cai ◽

Zhen Wang

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Operative Time ◽

Perioperative Complications ◽

Tumor Resection ◽

En Bloc Resection ◽

Bloc Resection ◽

Resection Rate ◽

En Bloc ◽

Gastric Submucosal Tumors

Abstract Background Endoscopic resection, including endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFR), was used to resect small gastric submucosal tumors (SMTs). Our team explored a method of tumor traction using a snare combined with endoclips to assist in the resection of SMTs. This study aims to explore the safety and effectiveness of the method. Methods This research performed a propensity-score-matching (PSM) analysis to compare ESD/EFR assisted by a snare combined with endoclips (ESD/EFR with snare traction) with conventional ESD/EFR for the resection of gastric SMTs. Comparisons were made between the two groups, including operative time, en bloc resection rate, perioperative complications, and operation-related costs. Results A total of 253 patients with gastric SMTs resected between January 2012 and March 2019 were included in this study. PSM yielded 51 matched pairs. No significant differences were identified between the two groups in perioperative complications or the costs of disposable endoscopic surgical accessories. However, the ESD/EFR-with-snare-traction group had a shorter median operative time (39 vs 60 min, P = 0.005) and lower rate of en bloc resection (88.2% vs 100%, P = 0.027). Conclusions ESD/EFR with snare traction demonstrated a higher efficiency and en bloc resection rate for gastric SMTs, with no increases in perioperative complications and the costs of endoscopic surgical accessories. Therefore, the method seems an appropriate choice for the resection of gastric SMTs.

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Minimally Invasive Pediatric Surgery: The Learning Curve

European Journal of Pediatric Surgery ◽

10.1055/s-0040-1703011 ◽

2020 ◽

Vol 30 (02) ◽

pp. 172-180

Author(s):

Marie Uecker ◽

Joachim F. Kuebler ◽

Benno M. Ure ◽

Nagoud Schukfeh

Keyword(s):

Postoperative Complications ◽

Minimally Invasive ◽

Learning Curve ◽

Clinical Outcomes ◽

Surgical Procedures ◽

Operative Time ◽

Learning Curves ◽

Current Evidence ◽

Stenosis Rate ◽

Mucosal Perforation

AbstractThe use of minimally invasive surgery (MIS) in pediatric patients has increased over the past decades. The process of mastering a new procedure is termed the learning curve, during which the ability to operate increases but poorer outcomes are produced. We aim to analyze the current evidence on learning curves in pediatric MIS and evaluate its impact on patient's clinical outcomes. A systematic literature search was performed for studies listed on PubMed that reported on the learning curve for MIS surgical procedures. Studies were included if they stated the number of procedures required to reach a consistency in outcomes or if they compared outcomes between early and late period of MIS experience regarding the endpoints operative time, conversions, and intra-/postoperative complications. A total of 22 articles reporting on 11 surgical procedures were included in the study. Most authors reported a significant decrease in operative time as well as peri- and postoperative complications with increasing experience of the surgeon. Complications ranged from minor to major, the latter being especially severe for patients receiving pyloromyotomy (5–7% higher risk of mucosal perforation), esophageal atresia repair (15% higher leakage rate and 19–77% higher stenosis rate), or Kasai portoenterostomy (26–35% more liver transplants in the first year after surgery) during the learning curve period. Pediatric MIS comes with a considerable learning curve that may have a significant impact on the patient's clinical outcomes. Efforts should be made to minimize the effect of the learning curve on the patients.

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